Acquired Visual Loss Attributed to an Accommodative Dysfunction

Abstract

Objective: To observe binocular vision characteristics in the diagnosis and treatment of accommodative dysfunctional vision loss patients. Methods: In this retrospective study, 25 participants with accommodative dysfunctional vision loss were enrolled at the Ophthalmic Center, Wuhan General Hospital of the People's Liberation Army from February 2014 to February 2016. All patients had routine examinations that excluded eye disease, amblyopia risk factors, and systemic disease. Based on binocular vision characteristics, all patients participated in visual function examination and training. Each patient’s binocular vision was checked under cycloplegia to assess the effect of accommodative relaxation on visual acuity and binocular vision. All data were statistically analyzed with paired t-tests and Wilcoxon tests. Results: Patients ranged in age from 6 to 24 years. Four patients were misdiagnosed as retrobulbar optic neuritis, one patient's symptom was poor uncorrected visual acuity (UCVA) after orthokeratology, two patients were referred to us because of blurred vision after femtosecond LASIK surgery, eleven patients' vision declined after overuse of eyes, seven patients complained of reduced distance vision only. The patients' baseline (25 cases) uncorrected visual acuity was 4.19±0.34, and the spherical equivalent (SE) was -7.95±3.10 diopter (D), the best corrected visual acuity (BCVA) was 4.28±0.32. After cycloplegia with tropicamide eyedrops (21 cases), the SE was -0.06±0.86 D, the BCVA was 4.43±0.15. After using atropine eye ointment (14 cases), the SE was +1.24±0.84 D, the BCVA was 4.93±0.14. After 3 months' vision training, visual function indexes improved. Negative relative accommodation before and after training was 1.76±0.61 D, 2.49±0.15 D (t=-3.780, P<0.001). Positive relative accommodation was -1.26±0.76 D, -2.43±0.34 D(t=3.977, P<0.001). Accommodative facility was 0 cycle/min (cpm), 10.6 cpm (Z=-4.012, P<0.001). BCVA and SE remained stable. Conclusions: Patient functional vision loss was caused by accommodative abnormities. Upon basic treatments combined with visual function examination and training, visual acuity was improved and remained stable. Key words: accommodative dysfunctional vision loss; visual function examination; visual function training